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:" RCC4(11178) COMMONWEALtH OF PENNSYLVANI~ ~, " ~ ~
u NoJ003309 DEPARTMENT OF REVENUE ' " ",' " ,
,: OFFICtAL RECEIPT. PENNSYLVANIA tNHERlTA~i: Aitli?',~t4~~ ~," ,\
~t1: ,:~ L~~"~ j .,10+
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= RECEIVED ------------------TBIRTY-EIGRT Ir: 1
i~ I
~'
;,-,1 From:
It
'" Address
,.
III'
If
~
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Nome of Decedent
TOTAL AMOUN(ltll{--... ..' $. ,A 'f
'{' '~
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Received by j \:::::..XAA \~ .-
NOTE, In Q(ceptlng the transfer inheritance tax on future estates, prior to the death of the life (SJ.gnat,,~)
lenont or lenont for years, os evidenced by this re(eipl, it is understood thol the Commonwealth shall R1cba.rd J!i. AJlC1er80n
001 b. '''''vd.d 0' ,"..o,.d f'om h"'of", 0"''''09 oddit'oool 'oh"itoo," I" 01 'h. d'olh of Ih. ~.<<1.t.r ~t Wi 11.
life lenonl or lenonl for years whenever it appears that such additional lox may be legally due and ( itle)
collectible for any reason whatsoever.
, (au nty
Remarks:
100-----__ ---.------- -- .....-___ -dollars
C!ClIr9 flAnk_ ltT.A ,
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
21st & Market Streets
2% Tax on
$
$
CamD Hill.h.
17011
6% Tax on
$
$
0, 21-78-127
2-24-1978
Dote of Death_
15% Tax on
$
$
of Payment
I
.July ] 3. ]979
% Tax on $
Estate Tax, Act of
Moy 7, 1927
$
lmWA.Rn T.. RYA.N
$
Cumberland
TOT Al TAX CREDIT
less five percentum of tax if
paid within three months after
dote of death
Plus interest at .he rate of
_%from
fo
$
JR,]5
PAID OR ACCOUJiT.
$
$
'[j'OO~[PLl~@ill'[j'rn
5 E A l
NOTE: This Triplicate Receipt to be retained for audit purposes.
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